Ambulatory RCM Services 2020
Dynamic Market Changes and New Players

Strong Partnerships from athenahealth & Newcomers R1 RCM, Bolder Healthcare Lead to High Satisfaction

R1 RCM, athenahealth, and Bolder Healthcare Solutions (the latter with limited data) are the firms in this report most likely to be described by customers as partners focused on client success, though each is strong for different types of organizations. R1 RCM serves both large and small clinics and also has a presence in the acute care RCM services space. athenahealth’s RCM services are part of their integrated ambulatory offering, and most client respondents are small to midsize clinics. Bolder Healthcare clients are mostly anesthesia groups, and the firm also has an acute care revenue cycle presence. While many ambulatory RCM firms use contingency models (i.e., the firm only makes money if the client does), R1 RCM, athenahealth, and Bolder Healthcare stand out for also driving increased revenue and working hand in hand with clients to make sure available revenue is collected efficiently. The firms also drive revenue collection by proactively innovating their tools and processes. All three customer bases report being able to reduce office staff as a result of their firm’s services.

Inconsistent Delivery of Revenue Cycle Outcomes Drags Down Satisfaction with eMDs, CareCloud & Greenway Health

athenahealth, Allscripts & NextGen Healthcare Showing Recent Performance Improvement

athenahealth customers report a fairly consistent experience—overall scores range from the high 70s to the low 80s—and in the last year, satisfaction has increased slightly, leading the firm to win the 2020 Best in KLAS award for ambulatory RCM services. Clients say that athenahealth shoulders many of the burdens associated with revenue cycle operations and supports a faster A/R cycle. They also cite recent support improvements stemming from better account management and executive involvement. Ambulatory organizations using Allscripts have seen a considerable rise in overall satisfaction (nearly 10 points) across the past two years because of newly implemented account managers, increased executive communication, and improvements in Allscripts personnel’s knowledge and capabilities. After a drop in satisfaction from 2018 to 2019, NextGen Healthcare clients saw an uptick in 2020. While the vendor’s performance is still about average, clients are generally hopeful their experience will continue to improve; they cite recent positive moves from NextGen Healthcare in areas such as keeping promises, communicating, and being innovative in their revenue cycle technology.

High Number of Recent Acquisitions—Most Firms Holding Steady; eMDs Clients Hurting the Most

Six of the eight firms measured in this report have been acquired in the last few years.^† Past KLAS research shows that most acquisitions result in a solid uptick or downturn in customer satisfaction 12–18 months post-acquisition. Allscripts, athenahealth, Bolder Healthcare, and R1 RCM clients talk about the transitions they experienced as either largely uneventful or as actually improving their experience. The effects of the 2020 acquisition of CareCloud by MTBC remain to be seen, though clients were already experiencing a decline before the change was announced. eMDs’ 2019 acquisition of Aprima^‡ has resulted in significant satisfaction declines. Today, 80% of acquired clients are dissatisfied with the firm’s services, and all attribute this to acquisition-related problems. Respondents report that after eMDs reorganized the RCM unit, aforementioned issues with support, communication, and executive involvement arose, and knowledge gaps appeared. This has resulted in more mistakes that then lead to lower-than-expected collections, higher A/R days, and negative impacts on patient-provider relationships. In light of this poor experience, many clients who used to be satisfied are now reconsidering their future plans with eMDs.
_{† For details on recent mergers and acquisitions in the ambulatory RCM market, see the About This Report section on page 8 of the full report.
‡ About two-thirds of interviewed eMDs clients use the Aprima revenue cycle platform; the remainder use other eMDs platforms. There is little difference in the experiences and satisfaction of these groups.}